13-CREDIT EXEMPTION REQUEST

DIRECTIONS
The 13-credit flat tuition rate applies only to undergraduate students.
Unless you have prior approval, you must pay the 13-credit flat tuition rate even if you register for 12 or fewer credits. Any credits
beyond 13 are available at no additional charge.
You are automatically exempt (and do not need to submit an exemption request) if you are an undergraduate student who:
has a disability for which Disability Services has determined that a reduced credit load is an appropriate accommodation.
works for the University and is enrolled on a Regents Scholarship.
is enrolled as a non-degree student.
You may petition to take fewer credits any time before the end of the fourth week of the semester.
If you have life circumstances that prevent you from enrolling full time, submit a completed exemption request form to your college advising office, along with any additional documentation required by your college. You may be approved for exemption if,
for example, you are an adult student with full-time employment or child-care responsibilities; a graduating senior who needs fewer
than 13 credits to graduate; have an illness or incapacity of short-term duration; or have a unique academic opportunity that precludes full-time status. For complete information on the 13-credit policy, go online to onestop.umn.edu/registration/guidelines/credit_load/. If you are unable to enroll full-time for medical reasons, have a medical provider or Disability Services complete a Medical
Supplement (http://policy.umn.edu/forms/otr/otr174.pdf) to document these circumstances.
If your request is approved, you will be billed only for the credits you take, at the per credit rate.
To ensure privacy online, open in Adobe Reader (free at Adobe.com). Please add the required signature(s) in blue or black ink.

PART 1: Student background

University ID

Name (last, first, middle)

Birth date (mm/dd/yyyy)

University email address

Phone (include area code)

@umn.edu

Current mailing address (street, apartment number or PO box number, city, state, ZIP code)
Major/degree program

College

PART 2. Reason for exemption request

Please indicate the duration of the exemption:
Permanent exemption continues during each semester that you are enrolled as a degree-seeking student. If approved, you are not
required to submit a new request each semester. However, you are required to update your information, if changes occur that impact your
exemption status.
Temporary exemption Approval applies to one semester only.
Term/year that the exemption is to begin or, if temporary, will be used:

fall semester 20 __ __

spring semester 20 __ __

Check all of the circumstances below that apply to you and describe the exception to be considered, if requested.
I am a graduating senior with fewer than 26 credits to complete.
I have a medical condition that limits my ability to take 13 or more credits. Please attach medical
documentation from your health care provider.
PART 2 continues on page 2
IMPORTANT: Print the online form after you have filled in the fields. Your responses WILL BE DELETED when you close the form file.

*OTR158*

The University of Minnesota is committed to the policy that all persons shall have equal access to its programs, facilities,
and employment without regard to race, color, creed, religion, national origin, sex, age, marital status, disability, public assistance status, veteran status, or sexual orientation. This form is available in alternative formats upon request. Please call
the liaison for Disability Services at 612-625-9578.
otr158 Page 1 of 2 2/13

PART 2 cont. Reason for exemption request

I have an internship, co-op program, or other unique educational or career opportunity that prevents me from taking
13 or more credits. Please describe:

I have significant family or financial responsibilites that prevent me from taking 13 or more cedits. Please describe:

I have work responsibilities that, in combination with one of the other factors above, preclude me from taking 13 credits.
Please provide your place(s) of employment and the number of hours you work each week for each job. Then, explain why
your work conflicts with enrolling for 13 or more credits.

Other factors that are important in my decision to request exemption from a 13-credit flat rate:

PART 3. Student certification

My signature below certifies that the information I have provided on this form is true and accurate to the best of my knowledge.
Student signature (required)

Date

office use only

academic adviser action taken
request is

recommended

not recommended

need more information

comments

signature of authorized adviser

date

college office action taken

request is

approved

approved with modification

denied

comments

signature of authorized collegiate staff (may be the academic adviser)

otr158 Page 2 of 2 2/13

date